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Preparing for a Medicare Audit Could Be Key to Avoiding Criminal Charges

Drew Duncan
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Partner at Zimmer, Duncan and Cole, LLP

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If you received a notice that your practice is being audited by the Department of Audits and Accounts (DOAA) or the Centers for Medicare and Medicaid Services (CMS), it does not mean they are conducting a criminal investigation. However, your audit could lead to criminal charges for Medicare and Medicaid fraud—especially if you make errors during your audit or do not handle it properly.

Five Tips for Handling Your Medicare Audit

The purpose of your audit is to find overpayments submitted to Medicare and Medicaid and recover these payments. The auditors will look for billing for services not provided, overbilling for services provided, and multiple billings for services when one bill should have been submitted. Here are some tips for helping the audit go smoothly:

  •  Contact your attorney. You have a right to have your attorney present when auditors are at your office and interviewing employees. Contact an attorney, and have him or her guide you through the audit process.
  •  Make sure your office looks professional. The auditors will open every drawer and cabinet and could photograph them. Be sure your office is clean and organized. Be certain that all displayed certificates, diplomas, and licenses are accurate and current.
  •  Have all medical records secured. Health records must be secured in compliance with the Health Insurance Portability and Accountability Act (HIPAA). Paper medical records should be locked in cabinets, and computer screens should be positioned to prevent patients and visitors from reading the screens.
  •  Keep a copy of all records provided. Keep a copy of all documents you give to the auditors for your attorney.
  •  Do not guess answers to questions. Instruct staff not to guess the answers to auditors’ questions. Advise your staff to be honest—including saying they don’t know the answer if that is the truth.

If you are being audited, you need to retain a criminal defense attorney immediately before you face charges. We’re here to help you through the audit process. Start an online chat today to schedule a free, no-obligation consultation.


Category: Criminal Defense


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